The Jakarta Pandemic

by Steven Konkoly

  The International Scientific Pandemic Awareness Collaborative (ISPAC) officially launched in February of 2010.

  Despite major political challenges, ISPAC founders garnered enough financial and political support from private sources to promote their agenda internationally, tirelessly lobbying national and regional government agencies directly involved in public planning. Although small in size and of apparently limited influence, ISPAC created three regional operations centers, dedicated to coordinating ISPAC efforts and monitoring potential pandemic threats. The first center, located in Atlanta, U.S., maintained close, but strained ties with the U.S. Centers for Disease Control. This relationship provided real-time virus tracking and research information and allowed ISPAC representatives to indirectly influence CDC programs.

  Although under U.S. government control, the CDC remained committed to exploring all available options and resources to prepare for another pandemic, remaining relatively impartial to ISPAC’s agenda at the CDC, despite WHO pressure to severe any and all ties to what they described as a fringe, doom and gloom organization. ISPAC located their next station appropriately in Seoul, South Korea, where they could travel to and interface with international agencies responsible for monitoring and tracking viral flu cases in Southeast Asia. Although much of this information was readily available from the CDC tracking database, developing ties to local agencies and governments directly in the path of initial flu outbreaks enhanced their credibility and provided critical tools for promoting their agenda. The final station settled in London, England, where ISPAC officials established a working relationship with the United Kingdom’s Department of Health, Infectious Disease Division.

  In response to the establishment of these centers, the WHO leveraged their international political weight to blockade ISPAC efforts to expand influence. Particularly, the WHO established a persistent presence at the UN, under the aegis of major UN charter members, where they regularly lobbed veiled threats toward UN member nations that interacted with ISPAC representatives. Mainland Europe, South America, Russia, and most regions of the world dependent on UN and WHO support, fully cooperated with WHO requests to sever ties with ISPAC and ignore future lobbying efforts. This essentially denied them access to a vast majority of international resources and influence, but did not render them ineffective.

  U.S. CDC and U.K. leadership remained unmoved and unimpressed by WHO intimidation, maintaining their commitment to a more objective and unbiased approach to pandemic disease planning and study. Furthermore, in the U.S. and the U.K., a general disdain for external political pressure, especially from international organizations like the UN or WHO, permitted ISPAC to continue limited operations with the CDC and U.K. Department of Health. Regardless of this stance, considerable political pressure, generated by powerful WHO influence, continuously pushed downward from each nations’ government, effectively prevented ISPAC from influencing major policy decisions regarding pandemic planning.

  Fortunately, due to these two key relationships and their unremitting field presence in Southeast Asia, ISPAC continued to maintain and enhance their own capacity to track potential pandemic virus. ISPAC established a public website and hotline system to provide real-time flu information to the world’s population. Information, publications, manuals and leading essays regarding pandemic planning remained constantly updated and available to the public and private sector, with the hope that this resource would be used to strengthen what they considered to be the most critical and neglected aspect of the pandemic defense. In their view, the very least they could provide to the world was the earliest possible warning of a legitimate emerging pandemic threat, so that individuals and grass-roots-level organizations could make life-saving, immediate planning decisions. This became their focus and mission in the face of a nearly insurmountable blockade of their efforts to impact policy.

  ISPAC website resources and live-tracking updates continued to remain available to those with access to power and satellite website service until mid-January 2013.

  ISPAC and WHO Controversy following the 2008 Avian Flu Pandemic

  Linking apparently sound logic, scientifically-based statistical theories with a basic cautious approach to their contrarian views, they forwarded the notion that the world caught a break with the 2008 H5N1 strain. The H5N1 strain’s lower pathogenicity hovered around 6%, instead of the 40-50% seen with previous H5N1 strains. Also noted, the pandemic H5N1 strain displayed a quicker than normal asymptomatic to symptomatic shift. Infected individuals showed symptoms within 1-2 days, instead of the 3-5 day period seen in previous seasonal and pandemic flu strains. Since symptoms surfaced quickly, infected individuals were more rapidly detected, contained, and treated, greatly reducing the geographic spread of the virus.

  Scientists calculated that if the strain had behaved differently, with a longer asymptomatic virus shedding period, then the disease would have been harder to detect and contain, and easier to transmit. Consequently, the pandemic flu could have infected a significantly higher percentage of the population.

  Either scenario, higher pathogenicity or elevated transmission rates, could push pandemic response plans, national healthcare systems and social/essential services beyond their capacity to handle a pandemic. These scientists pointed to the disasters in Pakistan, Mexico City and Yugoslavia/Serbia as examples of what could happen everywhere in the world if just one of the scenarios materialized.

  Even worse, combining both pandemic scenarios, in their opinion, could trigger a global disaster of truly epic proportions. They simply forwarded the theory that, if any of the severely pathogenic H5N1 strains seen in 2005-2006 had made the antigenic shift to effective human-to-human transmission, then the world would have faced a more highly-contagious and transmittable strain of flu, with a 40-50% case fatality rate, that could be spread for days by individuals showing no outward signs of the virus. The outcome of this pandemic would have been drastically worse than the 2008 pandemic, regardless of the presence of an effective vaccine.

  Another key element fueling the contrarian view involved vaccines. When the 2008 pandemic started in China, an effective vaccine already existed for the deadly strain, and the international community put the vaccine into immediate wide-scale production on a level never seen before. If a novel strain evolved, most disease and health experts concur that it will take at least 4-6 months to develop an effective vaccine once the pandemic virus strain is identified by world health officials.

  Large-scale production of the vaccine would follow, after vaccine production facilities converted to the creation of the new pandemic vaccine. This conversion could add weeks, or possibly months to the entire process, followed by the difficulties of nationwide or worldwide distribution during pandemic conditions. Overall, the world could very likely be forced to wait 6-9 months before the general delivery of an effective vaccine. Even worse, the distribution of the new vaccine would follow national and international rationing protocols, further delaying widespread distribution of the vaccine.

  The world’s population will face a stark reality. The majority of people could be forced to live and survive in a hostile and deadly pandemic environment for nearly a year before receiving vaccination to the flu.

  Many of the critics paint a grim picture of this pandemic world. In 2008, for both modernized and developing nations, hospital-based care remained available to a vast majority of infected individuals, drastically improving outcomes and contributing heavily to the low overall case fatality rate. Although the situation in many developing nations approached, and in some cases, crossed the tipping point for the availability of hospital or clinic-based care, the modernized nations’ system was never truly challenged by the 2008 pandemic.

  The outcome would be different in the face of a deadlier and more infectious virus. The breakpoints for inpatient healthcare availability, in both modernized and developing nations, would be reached quickly, and the result would be catastrophic.

  The scenario described by these sci
entists was depressing, with statistics citing that within 2-3 weeks of a pandemic outbreak in a given area, all available inpatient services such as hospital beds, ventilators, observation rooms, medical staff, would be occupied. Based on 1918 pandemic flu patterns, within weeks, in the U.S. alone, the health care system would need 200% of all existing hospital beds, 500% of intensive care unit beds, and over 200% of ventilators to meet the flu demand. Once inpatient capacity was filled, patients would be given a set of home-based care instructions and turned away.

  The predicted survival rates for hospital-based care versus home-based care differ greatly, based on the severity of the patient’s flu symptoms and easily recognizable patient risk factors (age, chronic disease, and general health). The best example is demonstrated by patients in a medium-high risk category, who are typically either very young or very old, or have an underlying chronic disease that can lead to further complications (diabetes, heart disease, pulmonary disorder).

  For this group, patients treated within a stable and fully-resourced inpatient setting would survive at a rate of 80-85%, while patients treated in a stable home setting, with access to basic medical supplies, would be expected to survive at a rate of 40-50%. It is important to note that these figures applied to best-case scenarios in each setting, where access to power, water, medical supplies, competent medical personnel and equipment remains constant.

  The projected difference between the two, in even the best of circumstances, is remarkable. Once all inpatient services were occupied within the first few weeks of a more virulent pandemic flu, and basic medical stockpiles started to disappear, the expected rates of survival would plummet in both settings to 20-40%.

  Another notable difference predicted by ISPAC (International Scientific Pandemic Awareness Collaborative) was the widespread loss of essential services. Their public planning experts agreed that with the predicted onset of a more severe pandemic, the combination of a rapidly growing infection rate and an overwhelming fear of infection will lead to massive absenteeism rates for all sectors of public and private service. Inevitably, high absenteeism rates combined with rampant sickness will seriously deteriorate the reliability of fuel delivery and degrade both municipal and regional public service departments’ ability to repair, maintain and operate their systems.

  In a short period of time, once local fuel reserves are exhausted, or system repairs exceed the capability of remaining personnel, a general collapse of essential services like electricity, public water, food distribution, communications (phone, cable, cell phone) and public safety (fire and police) will follow. Eventually, even the hospitals and temporary pandemic treatment centers may face severe personnel shortages, exhaustion of essential supply stockpiles, and the loss of a stable power source.

  These experts found it nearly impossible to predict the duration of time that these essential services would be affected, only that the likelihood of losing many of these services was extremely high. Without basic survival needs, like running water, food, heat and medical supplies, they theorized that adequate home treatment of the flu would be nearly impossible, further exacerbating the flu’s case fatality rate.

  Given the inherent difficulty to predict the duration of an essential services black-out, experts began to voice concern for the basic survival prospects of non-infected individuals and flu survivors. Statisticians and epidemiologists cited that even in the most modernized parts of the world, like Europe and North America, very few families have an adequate stock of food or water to survive for even one week, and national food reserves might remain inaccessible to most population groups.

  Even if the food reserves were accessible, no coherent rationing plan existed, and in any event, on-hand reserve supplies would not last for more than a few weeks. Once the food and water distribution capacities are interrupted, even families who lived within a few miles of several major food stores would find it nearly impossible to procure safe food or water.

  The situation in the developing regions of the world was even more desperate. With no national food reserves, and in many cases a near complete dependence upon food importation or aid shipments, the populations of many developing nations would face an immediate food and clean water shortage, worsened case fatality rates and vastly increased nourishment-related deaths. Once aid shipments ceased, survival in a region currently threatened with severe drought or famine would be close to impossible for both infected and non-infected alike.

  Within these regions, ISPAC experts calculated that the death rates would catapult many regions into disastrous civil disorder. Given the likelihood that most national, regional and local civil protection capability will also be drastically diminished, an incendiary situation could develop, further adding to the chaos of the pandemic environment.

  ISPAC experts pointed to examples of civil chaos seen during the 2008 avian flu pandemic, specifically in Pakistan and Yugoslavia, where a near complete loss of civil order occurred in vast geographic areas, creating nearly impossible environments for local, national and WHO pandemic efforts. In both Yugoslavia and Pakistan, casualty rates rose drastically when flu cases quickly overwhelmed the health system capacity, further rising when a near complete loss of essential services followed. ISPAC predicted that the disasters seen in Pakistan and Yugoslavia would likely be repeated everywhere in the world, even in the most modernized nations, in the face of a severe pandemic.

  With their cautious and foreboding predictions, ISPAC representatives worldwide promoted a pandemic awareness and preparedness agenda that reached past WHO-supported measures. Although not diametrically opposed to WHO efforts, ISPAC dogma criticized the WHO’s monopoly of pandemic preparation and response. Since the apparent success of WHO efforts during the pandemic of 2008, the WHO billed itself as the sole provider of pandemic planning, preparedness and response for the world. As a result, many major nations decided to simply pay large financial sums to the WHO, letting them bear the burden of preparing for the next pandemic.

  ISPAC firmly believed that WHO involvement in the next pandemic will be critical to mitigating fatalities and fighting the pandemic on a large scale. However, given the frightening prognosis of a deadlier pandemic flu, ISPAC officials projected that the next pandemic would quickly render WHO plans irrelevant and ineffectual. They maintained that the bulk of the pandemic readiness and response will need to stem from individual households, municipal and regional governments, and the private service sector. In effect, the WHO plan acts like a shield to prevent or slow the flu’s breach of a region, but once the shield is overwhelmed, WHO plans provide little capability to fight an internal battle against the flu because WHO plans can’t be effectively reduced to smaller scale.

  Even worse, most nations allocated nearly all of their authorized pandemic preparedness funding to the WHO, leaving little funding left to seriously implement a domestic plan. Most nations had committees and departments that developed pandemic plans at all levels, but few countries empowered these entities to implement the plans and prepare. Unfortunately, ISPAC’s efforts to augment WHO plans met with considerable resistance by the WHO and the international community. The WHO sought to maintain their international pandemic planning monopoly, which yielded generous funding, and most nations had little interest or motivation to assume responsibility for further pandemic planning costs. It was easier for governments to write a check and pass the responsibility on to the WHO. After all, memories of the 2008 pandemic had long faded from the headlines and resurrecting them proved unpopular to voters worldwide.

  Field Resources Available in 2008

  In 1995, sponsors at Emory University, with International Society of Travel Medicine (ISTM) and CDC collaboration, established a system called GeoSentinel, which served to monitor emerging infections of potential global impact. Currently utilizing 41 GeoSentinel sites and 145 ISTM clinics on six continents, CDC and WHO officials can track the introduction and progression of diseases with pandemic potential. Since 2005, the main focus of the GeoSentin
el system has been the detection and tracking of H5N1 virus strains. GeoSentinel forms the backbone of the WHO’s Global Outbreak and Alert Response Network (GOARN).

  In 2005, the World Health Organization created specialized Forward Liaison Teams (FLT) to quickly respond to detected threats. Their purpose was to help host-country health officials to immediately develop and implement a grass-roots-level detection and reporting network beyond GeoSentinel, to further track and study the emerging threat. The network utilized national and local level representatives, comprised of health service providers and government service officials, to extend the surveillance capability within their area of responsibility. Once an effective system was developed, the FLTs would either remain in place to further develop host capabilities, or be re-deployed to another area of interest.

  In mid-May 2008, the WHO assembled and officially introduced the Rapid Response and Surveillance Team (RRST) to the world. The RRST’s operational capability was one of the key contingencies formulated between 2005 and 2008. These teams tirelessly scoured the planet, investigating potential virus outbreaks and reporting the findings to the WHO for immediate asset allocation. Typically, an RRST was deployed within hours of a credible virus report. The RRSTs operated under the full support of the United Nations’ military enforcement arm. Likewise, admittance and full cooperation with the RRST by the host governments was mandatory and noncompliance was decreed by the UN to be an immediate, hostile action against world safety and security. With the full weight of the UN members backing the WHO, the RRSTs operated unhindered.